腹膜后隙解剖

三、输尿管腹部
输尿管起于肾盂，终于膀胱，
全长约25～30cm。分为三部:
腹部、盆部、壁内部，其中腹 部长约13-14cm,紧贴腰大肌前 面向下内斜行，在腰大肌前面 中点处有睾丸（卵巢）血管斜
过其前方。
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
左侧睾丸静脉曲张较右侧 多见，原因如下： （1）左侧回流流程较长 （2）左侧睾丸静脉以直角 汇入左肾静脉，压力较大 （3）左侧前方有乙状结肠 跨过，易受其压迫 （4）左肾静脉在肠系膜上 动脉与腹主动脉夹角中回 流，受压时易累及左侧睾 丸静脉
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
（三）肾血管和肾段
1. 肾动脉和肾 段 肾段：每一段 动脉供给的 肾实质区域 称为肾段， 共5个。
January, 2007
上段动脉 上前段动脉 下前段动脉 下段动脉 后段动脉
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腹膜后隙
January, 2007
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一、概 述
腹膜后隙位置：位于腹后 壁，介于腹后壁腹膜与腹 内筋膜之间。 范围：上起膈，下至骶骨 岬，两侧续于腹膜外筋膜， 向下续于盆部的腹膜后间 隙。
肾蒂 ：出入肾门的结构合称肾 蒂，主要结构有肾动脉、肾 静脉、肾盂。 肾蒂内主要结构的排列关系: 由前向后依次为：
肾静脉、肾动脉、肾盂
从上向下依次为： 肾动脉、肾静脉、肾盂
January, 2007
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下腔静脉毗邻： 前方：肝脏、胰头、 十二指肠水平部及右 睾丸（卵巢）血管和 肠系膜根 后方：右膈脚、1-4腰 椎、右交感干和腹主 动脉的壁支 右侧：腰大肌、右肾 和右肾上腺 左侧：腹主动脉
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
毗邻（不同点）：
两肾内侧：
左肾：腹主动脉
右肾：下腔静脉 左肾前面邻： 胃 空肠 胰 结肠左曲
右肾前面邻：
肝右叶 结肠右曲
十二指肠降部
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
（四）肾的被膜
肾表面包有三层被膜，由内向外为：
纤维囊 脂肪囊
肾筋膜
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
肾的毗邻：
毗邻（相同点）：
两肾上端: 肾上腺
两肾后面：膈 腰大肌 腰方肌 腹横肌 腰大肌 膈肌
（二）肾门、肾窦和肾蒂
肾门： 肾的内侧缘中
部凹陷，是肾的血管、
神经、淋巴管和肾盂出
入肾的部位，称肾门。
肾窦：肾门深入肾实质 所围成的腔隙称为肾窦。
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
五、下腔静脉 Inferior vena cava
下腔静脉由左右髂总 静脉在第5腰椎右侧汇 合而成，收集下肢、 盆部和腹部的静脉。 下腔静脉在脊柱的右 前方沿腹主动脉右侧 上行经肝腔静脉沟， 穿膈的腔静脉孔，最 后开口于右心房。
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
四、腹主动脉 Abdominal aorta
腹主动脉沿脊柱左前方下
行，至第4腰椎下缘平面分为
左 、 右 髂 总 动 脉 ， 全 长 1415cm，其右侧邻下腔静脉。腹 主动脉可分为脏支及壁支，其 中脏支又可分为：成对的脏支 不成对的脏支
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
（三）肾的血管 （四）肾Leabharlann Baidu被膜
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
（一）肾的位置及毗邻
位置：肾位于脊柱两侧，紧 贴于腹后壁。由于肝的存 在，左肾略高于右肾。 左肾：上端平第11胸椎下缘 下端平第2腰椎下缘 右肾：上端平第12胸椎上缘 下端平第3腰椎上缘
学七 ）、 腰 交 感 干 （ 自
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
学八 ）、 乳 糜 池 （ 自
2.肾静脉
右肾静脉通常无肾 外属支，而左肾静 脉收纳左肾上腺、 左睾丸（卵巢）静 脉血，其属支与周 围静脉有吻合，借 此可建立门-腔静脉 间的侧支循环。
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
成对脏器的静脉：
3对： (1)肾静脉 左侧长于右侧 (2)肾上腺静脉 右侧注入下腔静脉 左侧注入肾静脉。 (3)生殖腺静脉 右侧注入下腔静脉 左侧注入肾静脉
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
两肾内下方：肾盂 输尿管
两肾内后方：左右腰交感干
January, 2007
腹横肌 腰方肌
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
腹主动脉毗邻： 前方：为胰腺、十二 指肠升部、小肠系膜 根 后方：为1-4腰椎及椎 间盘 右侧：下腔静脉 左侧：左交感干
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
二、肾 kidney
内容：
（一）肾的位置和毗邻
（二）肾门、肾窦和肾蒂
右输尿管前方为十二 指肠降部、升结肠血管、 回结肠血管、睾丸（卵 巢血管）、回肠末段。
左输尿管前方为十二 指肠空肠曲、降结肠血 管、斜行跨过的睾丸 （卵巢血管）。
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
主要结构：腹膜后 隙有肾、肾上腺、 输尿管、腹部大血 管、神经和淋巴结 等重要结构。(胰 腺、十二指肠已于 结肠上区内介绍)
（1）成对的脏支
有3对:
肾上腺中动脉
肾动脉
睾丸动脉(卵巢动脉)
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
肾区
竖脊肌外侧缘与第 12肋之间所夹的部位称
肾区（脊肋角）。在某
些肾疾病患者，叩击或
触压该区可引起疼痛。
January, 2007 Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG
（2）不成对的脏支
有3支：
腹腔干
肠系膜上动脉
肠系膜下动脉
January, 2007
Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG